Kostogriz O. Diagnostic and treatment of cartilage lesions of the knee joint (experimentally-clinical research)

In the work is represented retrospective analysis of treatment of 1180 patients with cartilage lesions of the knee and their consequences. It is proved that in the structure of closed injuries of the knee cartilage lesions and their effects make 73.9% of the total number of injured structures of the knee. Also there were systematized the factors and causes of unsatisfactory results of treatment and found typical diagnostic and treatment errors in all phases of treatment. In the experiment it is proved that by traumatic injuries of all layers of the cartilage defect self-recovery is not observed. Articular cartilage is not restored in the case of filling the defect with chondrocytes implanted into the hydrogel, when this complex is not fixed in the defect site. In the case of using of cultured autologous chondrocytes implanted on 2% agarose gel in the cartilage defect site and followed by fixation of the complex using biodegradable membrane at the site of the defect is formed regenerated body as an immature chondroid tissue that later integrates with the surrounding cartilage. In the work is represented the technology of enzymatic isolation of the chondrocytes to produce 5,3?106 chondrocytes from 3.0 grams of articular cartilage. At the same time, three times passaging of chondrocytes makes it possible to increase the number of therapeutically significant proliferous cells (107 cells / ml of hydrogel) without a tendency to their dedifferentiation in fibroblast cells. The analysis of disability as a consequence of knee injuries shows that the average age of first time disability is 50,6 ± 9,4 years. Based on biomechanical modeling it was found that cartilage defect with a diameter of 5mm is a clinically relevant defect in the injured joint. By increasing of the defect size the pressure in the cartilage is enhanced from 3,5MRa to 9,84MRa with a defect size of 20 mm. It was biomechanically justified the tactics of treatment and rehabilitation of meniscus lesions combined with cartilage injuries. Based on the results of treatment, we studied and suggested indications and contraindications for using microfracture and tunnelization at the site of the cartilage defect. When subchondral bone plate is intact it is appropriate to use microfractures, and when there are post-traumatic changes in that area or steonecrosis of the phenomena it is appropriate to use tunnelization. The most valuable diagnostic method of cartilage injuries is non-invasive MRI, the sensitivity of the MRI data to the arthroscopy data is increasing with the severity of the damage to the articular cartilage (from 0% with 1 degree of Chondromalacia to 45% with 4 degree of Chondromalacia and average - 18,75%). To investigate the severity of metabolic changes in the cartilage and the efficiency of reconstructive operations on the articular cartilage surface of the knee, especially at 3 and 4th degree of chondromalacia may be used clinical analyzes with biochemical markers. By applying our developed differential tactic of treatment of patients with cartilage lesions of knee joint, which takes into account the physical activity of the patient, the localization and pattern of injury we approached in a new way to the treatment and the individual rehabilitation of this category of patients and improved functional results of the damaged knee joint at 92% of patients based on the evaluation function on a IKDC, Lysholm and Tegner scales.